Reaching Families Through Primary Healthcare

China's primary healthcare system is both far-reaching and well-structured, and a growing body of research suggests it represents one of the most promising vehicles for delivering ECD interventions to families in rural areas. A central thread running through the symposium was that the infrastructure already exists; the challenge lies in making better use of it. This view was echoed by local pediatricians and preventative care representatives among the attendees, who brought frontline perspectives to the conversation.

Presentations from researchers at Shanghai Jiao Tong University explored how caregiver training group activities can be embedded within routine primary child healthcare services, and how digital technologies can be deployed within clinic settings to extend the reach and consistency of ECD support. Research from Zhejiang University complemented this by examining how child growth monitoring, a standard feature of preventive care, can be strengthened as both an evidence base and a practical touchpoint for developmental support.

Not only are preventive care and early intervention more cost-effective than reactive approaches in the long run, but they also provide better safeguards for the wellbeing of mothers and children. China's existing primary care infrastructure has the potential to deliver such preventive care at scale.

Supporting Children by Supporting Caregivers

Another strong theme presented was the importance of directing attention and resources toward caregivers themselves, not only the children in their care. This focus is central to REAP's own intervention work, and it was reflected throughout the symposium's presentations and discussions. Multiple speakers highlighted that the wellbeing, knowledge, and confidence of parents and other caregivers are among the most important determinants of early childhood outcomes.

Importantly, conversations went beyond training primary caregivers of children, who in Chinese households are typically mothers or grandmothers . Speakers discussed how to help different caregivers work together more effectively, and how to bring other family members — especially fathers and other male relatives — more meaningfully into the picture. This broader conception of caregiver support recognizes that child development happens within families and households, not just in the hands of a primary caregiver.

Several presentations underscored the need for integrated approaches that treat caregiver mental health and wellbeing as a core component of ECD programming rather than an afterthought, with evidence suggesting that well-designed interventions can produce durable changes in caregiver behavior and child outcomes. Research on complementary feeding practices added a further dimension, demonstrating how behavioral nudge approaches can shift caregiving practices around infant nutrition. The consistent message across these sessions was that investing in caregivers is investing in children.

Scaling What Works: The Role of Technology and Implementation Science

Perhaps the most forward-looking dimension of the symposium concerned the question of scale. A recurring challenge in ECD research is the gap between what works in controlled settings and what can be sustained and expanded across vast, heterogeneous rural populations. In a country as large as China, even the most cost-effective intervention will fall short of its potential without government funding and commitment to sustain it. Several presentations tackled this challenge directly, with a shared understanding that the responsibility of researchers is not only to develop effective programs, but to build the evidence base that demonstrates their value to policymakers.

Researchers from Stanford University presented findings from  two randomized controlled trials, examining how digital support tools and group parenting models can help upscale parenting interventions while retaining their effectiveness. A presentation from Sean Sylvia at the University of North Carolina, Chapel Hill introduced the Healthy Future Platform, which uses AI-enhanced curriculum delivery to support community health workers. The researchers share the vision that technology can deliver behavioral interventions more consistently and better tailor them to the needs of individuals.

Implementation science featured prominently too, with researchers presenting a framework for evaluating ECD programs not just on their outcomes but on the conditions that enable real-world adoption. Complementing this, cost-effectiveness analysis from researchers at Shanghai Jiao Tong University offered policymakers a concrete basis for prioritizing investments in primary-level ECD support — an increasingly important contribution as the field makes its case for government-backed scale-up.

Policy Dialogue: Building Bridges Between Evidence and Action

The symposium brought together not only academics but analysts from China's National Health Commission and other implementing organizations. This mix of voices gave the event a practical orientation that went beyond the research findings themselves. The participation of government representatives was itself a meaningful signal, reflecting both the importance China places on ECD and a genuine openness to hearing what scientists have to say about how to improve outcomes for young children and their families.

Discussions returned repeatedly to the question of how evidence generated in research settings can be translated into durable government policy and frontline practice. The presence of international participants underscored the global relevance of the questions being asked, and the value of cross-national dialogue in shaping the field.

Looking Ahead

The formal program of the symposium closed on March 28, but conversations continued on March 29 as participants strengthened old friendships and formed new connections on the group visit to Brussels. These conversations reflected a shared recognition that the challenges ahead — scaling proven interventions, sustaining political commitment, and bridging research and practice — require not just strong evidence, but strong networks of people committed to acting on it.

About the Organizers

The Stanford Rural Education Action Program (REAP) conducts research aimed at improving the lives of rural residents in China, with a particular focus on education, health, and early childhood development. KU Leuven is one of Europe's leading research universities and a longstanding partner in international development research.

Headlines about foreign companies establishing a foothold in China only to fail years later no longer surprise anyone. But why does this keep happening? Kenneth Wilcox, former CEO of Silicon Valley Bank (SVB) from 2001 to 2010 and author of The China Business Conundrum: Ensure that Win-Win Doesn't Mean Western Companies Lose Twice, argues that the answer comes down to mental models and preparation.

In a recent lecture hosted by the Stanford Center on China's Economy and Institutions, Wilcox explained that we all develop mental models — internal frameworks that help us interpret and navigate the world around us. We carry these models with us wherever we go, applying them instinctively to new situations and environments. The trouble, Wilcox argues, is that a mental model only holds up if the new environment resembles the one it was built for. And American mental models, more often than not, simply don't hold up in China.

Wilcox knows this firsthand. After a decade leading SVB, he and his wife moved to China in 2011 to open a Chinese branch of the bank. Things started smoothly enough — he secured a partnership with Shanghai Pudong Development Bank and obtained the necessary license — but it quickly became clear that the rules he'd spent his career following no longer applied. The license, for instance, permitted him to open the bank but barred him from conducting any business in renminbi, China's national currency, for the first three years. For a bank, this created an obvious problem: how do you pay staff, let alone operate, without access to local currency? The government's solution was a subsidy to cover operating costs during that period, along with an invitation to meet regularly with other banks and business leaders to share SVB's model and approach. After many such meetings, Wilcox's Chinese partners told him they had been so impressed with what they'd learned that they planned to open their own bank modeled on SVB's approach.

This, Wilcox explained, is a pattern that plays out with striking regularity in China. Foreign companies are lured in with the promise of a vast new market and eager local partners. They are then entangled in regulations and bureaucracy, kept afloat with subsidies while they wait for permission to operate more freely — all while their technology and intellectual property are quietly absorbed. Eventually, the foreign company is left with little choice but to close up and leave. Some companies see it happening but look the other way. Others don't recognize it until it's too late. Many never fully understand why they failed at all.

Wilcox traced all of this back to the limitations of mental models. American businesses tend to arrive in China assuming the environment will function more or less like home: keep your head down, stay out of politics, focus on the business, and you'll be fine. But that assumption doesn't hold in China, where the government and the Communist Party exert control over virtually every aspect of commercial life. The most powerful players routinely hold simultaneous roles — party member, bank executive, government official — all at once. It is precisely these unexamined assumptions, Wilcox concluded, that set so many Western ventures up to fail before they've even begun.